Transference and Resistance in Geriatric Psychotherapy1

When asked to give a survey of psychotherapeutic problems of old age, it is difficult indeed to limit my task. The growing avalanche of literature in the field is proof that the urge to write about the age of mass-senescence is greater than the number of existing facts and the amount of insight available at the moment. Amongst the books and articles written on the subject of geriatrics, I have found hardly any dealing with therapeutic techniques. The reluctance to work with the aged results from unresolved relationships with one's own parents. Yet, active psychotherapy is possible and can be successful in more than 50 per cent of senile cases, even when shock therapy has been applied unsuccessfully. Much depends on the therapist's patience and his ability to establish a satisfactory human relationship.

My own experiences have been gathered largely in the private practice of psychotherapy and psychoanalysis, in out-patient clinics in Holland and the Vanderbilt Clinic in New York.

It is difficult to define where the geriatric line starts. For practical purposes, I will choose the point where the decline of life is felt and observed. This comprises many of the postclimacteric, presenile and senile reactions which always appear in combination during somatic and psychological aging. I hope to show that they form a definite unit in relation to therapeutic technique. My oldest patients receiving regular analytically oriented psychotherapy were respectively 72, 73 and 82 years old.

Three problems stand out when one starts to treat old people. They are: 1. The dark chapter of the psychology of old age; 2. The change in psychotherapeutic techniques one has to apply; 3. The greater emphasis on occupational and social therapy.

The onset of involution and decline differs widely in many persons. We may suppose that much of it depends not only on the somatic body instrument and the decline of homeostatic capacities, but also on underlying compulsions